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MOTOR FUNCTIONS OF CNS

THE MOTOR SYSTEM
The motor cortex itself is divided into three subareas, each of which has a specific
motor function:
- Primary motor cortex
- The premotor area
- The supplementary motor area

Primary motor area

- Also called Broadmann Area 4.
- Occupies whole length of Precentral gyrus. Each primary motor area controls the
opposite side of the body.
- The whole body is represented upside down (vertical).
- Face, tongue and lips have much larger representation.
- Muscles for three functions have the maximum representation:
o Muscles for vocalization (maximum).
o Muscles for mastication m (2nd maximum).
- Primary motor cortex is involved in executing simple motor movements.

Premotor areas
- It is involved in complex patterns of movement. This area is important for
movements that involve multiple joints.
- It is involved in motor learning
- It is also involved in organizing or planning of motor sequence (of movements).

Supplementary motor area (medial premotor area)

- It is important for learning and performance of a memorized sequence of
movements in the absence of visual cues (without any external sensory input).
- The supplementary motor area is mainly involved in coordination of two hands, in
sequencing of complex movements and in triggering of movements based on
internal cues.

Premotor cortex (lateral premotor area):

- It receives inputs from sensory regions of posterior parietal cortex (sensory
association area).
- It is involved in programming of visually guided movements. Hence it is called
Sensorimotor transformation.
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DESCENDING TRACTS OF CNS

A. Pyramidal tracts
✓ Derive their name from the medullary pyramids of the medulla oblongata, which they
pass through.
✓ These pathways are responsible for the voluntary control of the musculature of the
body and face.
✓ Functionally, these tracts can be subdivided into two:
o Corticospinal tracts – supplies the musculature of the body.
o Corticobulbar tracts – supplies the musculature of the head and neck.
✓ Corticospinal:
o The corticospinal tracts begin in the cerebral cortex, from which they receive a
range of inputs. They originate from:
▪ 30% fibers- Area 4 (Broadman’s area)
▪ 30% fibers- Area 6
▪ 40% fibers- Sensory cortex
o They carry information from: Primary motor cortex, Premotor cortex,
Supplementary motor area.
o They also receive nerve fibres from the somatosensory area, which play a role in
regulating the activity of the ascending tracts.
o The neurones converge and descend through the internal capsule (a white matter
pathway, located between the thalamus and the basal ganglia).
o Further, the neurones pass through the crus cerebri of the midbrain, the pons and
into the medulla.
o In the most inferior (caudal) part of the medulla, the tract divides into two:
▪ The fibres within the lateral corticospinal tract decussate (cross over to the
other side of the CNS). They then descend into the spinal cord, terminating in
the ventral horn (at all segmental levels). From the ventral horn, the lower
motor neurones go on to supply the muscles of the body.
▪ The anterior corticospinal tract remains ipsilateral, descending into the spinal
cord. They then decussate and terminate in the ventral horn of the cervical
and upper thoracic segmental levels.
✓ Corticobulbar tract:
o Arise from the lateral aspect of the primary motor cortex.
o They receive the same inputs as the corticospinal tracts.
o The fibres converge and pass through the internal capsule to the brainstem.
o The neurones terminate on the motor nuclei of the cranial nerves.
o Here, they synapse with lower motor neurones, which carry the motor signals
to the muscles of the face and neck.

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Brown Sequard syndrome

✓ Hemisection of spinal cord on either side, typically in the cervical and thoracic
spinal cord region leads to interruption of normal function of nerve tracts in one
half of the spinal cord.
✓ Characterized by:
o Ipsilateral lower motor neuron paralysis due to lesion to the lateral
corticospinal tract at the level of the lesion.
o Contralateral loss of pain and temperature sensations below the level of
the lesion due to damage to the lateral spinothalamic tract which
decussates at the level of the spinal cord.
o Ipsilateral loss of tactile discrimination, vibratory and proprioceptive
sensations below the level of the lesion. This is due to the lesion to the
Dorsal Column of the spinal cord.
o Contralateral partial loss of tactile sensation below the level of the lesion.
o Ipsilateral spastic paralysis below the level of the lesion.

B. Extrapyramidal tracts
All fibers outside the pyramids in the medulla constitute the Extrapyramidal fibres. They
do not enter the corticospinal tract. Instead they relay in: (i) Subcortical grey matter
(basal ganglia), (ii) vestibular necleus, (iii) Red nucleus, (iv) Tectum.
The main function of EPS is to regulate the tone of muscle and posture. It helps to
provide appropriate and stable postural background for the muscle activity produced by
the pyramidal tracts.

The principal tract of EPS are:

1. The Vestibulospinal tract-
a. Arises from the vestibular nuclei of pons and medulla and descends
uncrossed and projects on the alpha motor neurons.
b. It controls posture & equilibrium
2. Reticulospinal tract-
a. Arise from the reticular formation in the brainstem and descent mostly
ipsilaterally in the spinal cord.
b. Most fibres remain uncrossed but some fibres become crossed.
c. They project on both alpha and gamma motor neurons.
d. This tract affects and controls both voluntary and involuntary activity.
e. Controls trunk muscles.
Above both tracts control axial muscles
3. Rubrospinal tract:
a. Arises from the red nucleus of midbrain.
b. The tract crosses midline (Forel’s decussation) and descends contralaterally
to terminate on the ventral horn (α-motor neuron) of spinal cord.

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c. Controls proximal muscle tracts and affects both voluntary and involuntary
activity.
4. Tectospinal tract:
a. Arises from the superior colliculi of the midbrain and crosses to descend
contralaterally.
b. This tract controls reflex postural activity in response to visual stimuli. Hence
it coordinates movements of the head in relation to vision stimuli.

Upper Motor vs Lower Motor Neuron Lesions

Upper motor neurons are the neurons that descend from the cerebral cortex, cerebellum
and brain stem to terminate on the neurons that directly innervate the muscle i.e. α–
motor neurons.
UMN include corticospinal (pyramidal) and extrapyramidal tracts.

Lower motor neurons are the neurons that directly innervate the muscle. These are α-
motor neurons of ventral horn of spinal cord.

UMN lesions cause spastic paralysis. This is principally due to injury to the
extrapyramidal tracts.
Overall UMN lesions show:
✓ Spasticity with clasp knife rigidity
✓ Exaggerated deep tendon reflex
✓ Absent superficial reflex
✓ Positive Babinski sign (extenser plantar response)
✓ Clonus

Lower Motor Neuron lesions: their characteristics include:

✓ Segmental paralysis of all voluntary movements.
✓ Hypotonia and flaccidity.
✓ Loss of deep tendon reflex and superficial reflex.
✓ Fibrillation and fasciculation due to denervation hypersensitivity and spontaneous
activity.
✓ Wasting atrophy and contracture of the affected muscles.

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Decerebrate Rigidity
✓ It occurs when there is a lesion of the at the level of upper border of midbrain.
✓ Section at this level leads to loss of all activity of the cortical pyramidal fibres and
the rubrospinal tract. The reticulospinal tract remains intact.
✓ Since the -motor neuron discharge remains intact with loss of all other input,
increased muscle tone and decebrate rigidity take over.

Decorticate rigidity
✓ Produced by removing the whole of the cerebral cortex but leaving the basal ganglia
intact.
✓ It is characterized by flexion of upper extremities at elbow and extension at the lower
extremities.
✓ The rigidity is not as rigid as the decerebrate rigidity.

THE CEREBELLUM
• Cerebellum a structure that is located at the back of the brain, underlying the
occipital and temporal lobes of the cerebral cortex.
• Although the cerebellum accounts for approximately 10% of the brain’s volume, it
contains over 50% of the total number of neurons in the brain.
• The cerebellum consists of two hemispheres which are connected by the vermis, a
narrow midline area. The cerebellum consists of grey matter and white matter:
- Grey matter – located on the surface of the cerebellum. It is tightly folded,
forming the cerebellar cortex. The gray matter of the cortex divides into three
layers:
o An external - the molecular layer; contains two types of neurons: the outer
stellate cell and the inner basket cell.
o A middle - the Purkinje cell layer;
o An internal - the granular layer.
- White matter – located underneath the cerebellar cortex. Embedded in the white
matter are the four cerebellar nuclei (the dentate, emboliform, globose, and
fastigi nuclei).

Anatomical Lobes of Cerebellum

There are three anatomical lobes that can
be distinguished in the cerebellum. These
lobes are divided by two fissures – the
primary fissure and posterolateral fissure;
- The anterior lobe,
- The posterior lobe
- The flocculonodular lobe. It is the
oldest part of the brain in
evolutionary terms (archicerebellum)
and participates mainly in balance
and spatial orientation. Its primary connections are with the vestibular nuclei,
although it also receives visual and other sensory input.

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Functional subdivisions of cerebellum

A. Vestibulocerebellum.
✓ Comprises of the flocculonodular lobe and its connections with the lateral vestibular
nuclei.
✓ Phylogenetically, the vestibulocerebellum is the oldest part of the cerebellum.
✓ As its name implies, it is involved in vestibular reflexes (such as the vestibuloocular
reflex; see below) and in postural maintenance.
B. Spinocerebellum.
✓ The spinocerebellum comprises the vermis and the intermediate zones of the
cerebellar cortex, as well as the fastigial and interposed nuclei.
✓ As its name implies, it receives major inputs from the spinocerebellar tract.
✓ Its output projects to rubrospinal, vestibulospinal, and reticulospinal tracts.
✓ It is involved in the integration of sensory input with motor commands to produce
adaptive motor coordination.
C. Cerebrocerebellum.
✓ The cerebrocerebellum is the largest functional subdivision of the human
cerebellum, comprising the lateral hemispheres and the dentate nuclei.
✓ Its name derives from its extensive connections with the cerebral cortex, via the
pontine nuclei (afferents) and the VL thalamus (efferents).
✓ It is involved in the planning and timing of movements. In addition, the
cerebrocerebellum is involved in the cognitive functions of the cerebellum.

4 deep nuclei of cerebellum are: 5 cells of Cerebellum are:

✓ Dentate ✓ Purkinje
✓ Emboliform ✓ Granular
✓ Fastigial ✓ Golgi
✓ Globose ✓ Stellate
✓ Basket

Neuronal circuits:
✓ Afferent fibres for cerebellum come through two fibres- climbing fibres and Mossy
fibres.
✓ Climbing fibres which which bring information only from the inferior olivary nuclei
and establish excitatory synapses with Purkinje cells.
✓ All other afferent inputs to the Cerebellum is brought by other types of fibres called
Mossy fibres which establish excitatory synapse with granule cells I nthe granular
layer.
✓ The granule cell axons, called the parallel fibres, stimulate the Purkinje cells. Thus,
Mossy fibre input excites the Purkinje cells.
✓ The parallel fibres also stimulate three types of interneurons: Stellate and basket
cells in the molecular layer and Golgi cells in the granular layer.
✓ Stellate and basket cells inhibit the Purkinje cell.

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✓ Overall the climbing fibres exert a strong excitatory effect on a single Purkinje cell
while the mossy fibers exert a weak excitatory effect on many Purkinje cells.
✓ The ouptu of the cerebellar cortex discuassed above, is complex. Ultimately the
signal is projected from the cortex to the deep cerebellar nuclei via the axons of the
Pyramidal cells.
✓ The output of the Purkinje cells is inhibitory to the deep cerebellar nuclei.
✓ However, the output of the deep cerebellar nuclei to the thalamus and brain stem is
always excitatory.

Main Functions of cerebellum

- Essential for making fine adjustments to motor actions. Cerebellar dysfunction
primarily results in problems with motor control.
- Regulation of tone, posture and equilibrium
- Smoothening and coordination of voluntary movements- most important function
- Coordination of eye movements
- Planning and initiation of movements
- Timing of movements and comparison
- Four principles are important to cerebellar processing: feedforward processing,
divergence and convergence, modularity, and plasticity.
- Signal processing in the cerebellum is almost entirely feedforward. Signals move
through the system from input to output with very little internal transmission.
- The cerebellum both receives input and transmits output via a limited number of
cells.

Lesions of cerebellum produces:

✓ Hypotonia ✓ Rebound phenomena
✓ Ataxia ✓ Disquilibrium
✓ Intention tremor ✓ Nystagmus
✓ Dysmetria ✓ Decomposition of movements
✓ Dysdiadochokinesia

Note that there is no sensory deficit or paralysis but motor coordination is prominent in
all voluntary muscles.

Lateral cerebellar lesion produce:

- Dysmetria- inability to control range of movements. E.g. past pointing
- Asynergy and ataxia
- Intentional tremor- no tremor at rest, but movement causes tremor
- Dysdiadochokinesia
- Inability to do rapid alternating movements
- Dysarthria- defect in speech
- Rebound phenomenon- inability to control movement of extremity when opposing
forceful restrain is suddenly released.
- Hypotonia and Pendular tendon reflex.

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BASAL GANGLIA
✓ Refers to a group of subcortical nuclei responsible primarily for motor control, as
well as other roles such as motor learning, executive functions and behaviors, and
emotions.
✓ It comprises subcortical masses of grey matter
✓ Parts of Basal Ganglia
1. Caudate nucleus
2. Putamen
3. Globus Pallidus
4. Substantia nigra
5. Subthalamic nucleus/ body of Luy’s – Secretes glutamate and is only excitatory
cerebellar nucleus.
Note
Corpus striatum= Caudate nucleus+ Putamen
Lentiform nucleus- Putamen+ Globus Pallidus

Functions of Basal ganglia:

- Basal ganglia is involved in planning and programming of movement.
- Putamen circuit is involved in complex pattern of motor activity and skilled
movement.
- Involved in regulation of tone and posture.
- Caudate nucleus plays a major role in cognitive control of motor activity.

Features of Basal ganglia disorder:

1. Resting tremor {Hallmark of Parkinsonism)
2. Rigidity: cogwheel and lead pipe type
3. Akinesia or bradykinesia
4. Athetosis: putamen lesion
5. Hemiballismus: subthalamic nucleus lesion
6. Chorea: caudate nucleus lesion

Diseases of Basal ganglia-

✓ Parkinsonism: loss of dopamine containing neurons in substantia nigra
(nigrostriatal tract).
✓ Huntington disease: degeneration of the striatum (mainly caudate nucleus) with
selective loss of GABAergic and cholinergic neurons.
✓ Wilson’s disease or hepatolenticular degeneration: lenticular nuclei (pallidus and
putamen) affected due to excess copper deposition.
✓ Athetosis- affects Globus pallidus nuclei mainly and subthalamic nuclei.